Presentation and treatment of spontaneous aortocaval fistula

BACKGROUND: Spontaneous rupture of abdominal aortic aneurysm into the inferior vena cava is rare. The clinical presentation is highly variable, and the diagnosis can be difficult, often being made only at operation. The aortocaval fistula results in a large left-to-right shunt, which can cause cardiac failure. Once the diagnosis is made, treatment is by surgical closure of the fistula and repair of the aneurysm with a graft. METHODS: This is a retrospective review of a single surgeon's experience with aortocaval fistula complicating abdominal aortic aneurysms. RESULTS: Over a 15-year period, we had five patients with spontaneous aortocaval fistula who were treated operatively. Preoperative diagnosis was made in two, suspected in one, and not made in two, one of whom died (the only perioperative death in the series). CONCLUSIONS: Spontaneous aortocaval fistulas are uncommon, and their preoperative recognition is difficult. Hematuria in association with an abdominal aortic aneurysm should raise the suspicion of an aortocaval fistula. Surgical correction is possible, with survival rates comparable to those associated with rupture of aneurysms into the retroperitoneum. Early operative control of the fistula is important to optimize the preload to the heart.     

Saccadic system functioning among schizophrenia patients and their first-degree biological relatives.

In Study 1, 30 schizophrenia Ss and 27 nonpsychiatric comparison Ss were presented with a fixation task, a visually guided reflexive saccade (prosaccade) task, a predictive tracking task (0.4-Hz square wave), and an antisaccade task. The 2 groups did not differ on either the fixation or prosaccade tasks. Schizophrenia Ss had an increased number of errors on the antisaccade task and had decreased rightward visually guided saccade amplitudes during the predictive tracking task. In Study 2, 13 psychiatric comparison Ss and 32 1st-degree biological relatives of the schizophrenia Ss were compared with the schizophrenia Ss and a larger and older sample of nonpsychiatric Ss (n?=?33) on the predictive tracking and antisaccade tasks. The groups did not differ on predictive saccadic tracking. The schizophrenia Ss and their 1st-degree biological relatives made more errors on the antisaccade task than both the nonpsychiatric and psychiatric comparison groups (who did not significantly differ). Results are consistent with the notion that dysfunction of dorsolateral prefrontal cortex, caudate nucleus, or both is related to liability for schizophrenia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Duration of treatment with progesterone and regression of persistent ovarian follicles in cattle

The objective of the present study was to determine the duration of elevated concentrations of progesterone necessary to induce atresia of persistent ovarian follicles. Heifers were administered 25 mg of PGF2alpha on d 6 and 7 (d 0 = d of synchronized estrus) and a norgestomet implant from d 6 to 14. Ovaries were monitored by ultrasonography, and blood samples were collected on d 3, 5, 7, 9, 11, and 12 and daily from d 14 until ovulation. On d 12, heifers received either two progesterone-releasing intravaginal devices (PRID) for 6 h (6-h; n = 5), two PRID for 24 h (24-h; n = 5), or no treatment (CON; n = 5). Blood samples were collected at 15-min intervals from h -6 to 30 (PRID insertion = h 0) and analyzed for concentrations of LH. Characteristics of LH secretion were determined for consecutive 6-h periods (Period 0 to 5). Hourly blood samples, collected from h 0 to 29, were analyzed for concentrations of 17beta-estradiol (estradiol) and progesterone. The dominant ovarian follicles present on d 7 increased in size to 15.4+/-.3 mm on d 12 ("persistent follicle"). Following removal of the PRID and norgestomet implants, atresia of persistent follicles and ovulation of new follicles were induced in one of five and in four of five heifers in the 6-h and 24-h treatments, respectively. Persistent follicles ovulated after withdrawal of norgestomet in all other heifers. Concentrations of progesterone were increased from h 1 to 7 in the 6-h and h 1 to 26 in the 24-h treatment. Frequency of LH pulses was reduced (P < .05) during Periods 1 to 2 in the 6-h and Periods 1 to 5 in the 24-h treatment relative to the CON treatment. By h 10, concentrations of estradiol in the 6-h and 24-h treatments were lower (P < . 05) than in the CON treatment. This suppression continued through h 29 in the 24-h treatment (P < .05), whereas concentrations in the 6-h treatment were intermediate to those of the CON and 24-h treatments after h 14. Suppression of pulsatile LH release and estradiol secretion was evident with 6 and 24 h of treatment with progesterone, but only the 24-h treatment induced atresia of persistent follicles in a majority of the heifers.     

Computerized container-ship load planning: A methodology and evaluation

A heuristic is developed to plan loads for containerized cargo ships. It is designed to serve a port which uses gantry cranes (transtainers) and trucks to handle containers. The model recognizes constraints on ship stability, placing containers in a bay with the proper length, limits on stack height in under-deck bays, limits on stack weight in on-deck bays, refrigerated containers, and the need for support under a container. Provisions are made for the operator to handle overstowage of cargo for different ports and placement of oversize cargo. The model uses minimization of transtainer movement time and minimization of rehandles in the yard as an objective. The heuristic uses strategies for container placement similar to those used in manual load planning. A test of two ships and four voyages at the Port of Portland produced feasible load plans for each voyage. Transtainer movement and rehandling time varied for the four voyages; but on the average, the heuristic reduced a composite material handling measure by 4.8%.     

Bending of single crystal thin films modeled with micropolar crystal plasticity

The scale-dependent mechanical response of single crystal thin films subjected to pure bending is investigated using a dislocation-based model of micropolar single crystal plasticity via finite element simulations. Due to the presence of couple stresses, the driving force for plastic slip in a micropolar crystal contains an intrinsic back stress component that is related to gradients in lattice torsion-curvature. Strain gradient-dependent back stresses are a common feature of various types of generalized crystal plasticity theories; however, it is often introduced either in a phenomenological manner without additional kinematics or by designating the plastic slips as generalized degrees-of-freedom. The treatment of lattice rotations as fundamental degrees-of-freedom instead of plastic slips greatly reduces the complexity (computational expense) of the single crystal model, and leads to the incorporation of additional elastoplastic kinematics since the lattice torsion-curvature is taken as a work-conjugate continuum deformation measure. A recently proposed single criterion micropolar framework is employed in which the evolution of both the plastic strains and torsion-curvatures are coupled through the use of a unified flow rule. The deformation behavior is characterized by the moment-rotation response and the dislocation substructure evolution for various slip configurations and specimen thicknesses. The results are compared to analogous simulations carried out using a model of discrete dislocation dynamics as well as a statistical-mechanics inspired, flux-based model of nonlocal crystal plasticity. The micropolar model demonstrates good qualitative and quantitative agreement with the previous results up to certain inherent limitations of the current formulation.     

Growth and reproduction characteristics of purebred and crossbred dairy cattle in first lactation

Breed additive, maternal, and heterozygotic effects on 11 monthly postpartum body weights, average size, weight gain, age at first calving, and days open were estimated by linear regression analyses from records of 680 purebred and crossbred animals. Calving year, age, and milk yield were significant environmental effects. Positive regressions of age on body weights indicated late calving cows were heaviest postpartum and had most days open. Negative regressions of milk yield on weight gain and postpartum weight showed greatest losses of weight associated with highest yields. There were breed differences in growth; purebreds highest to lowest were Brown Swiss, Holstein, Red Dane, Jersey, and Ayrshire and for weight gain, Brown Swiss, Ayrshire, and for weight gain, Brown Swiss, Ayrshire, Jersey, Holsteins, and Red Dane. Crosses were superior to purebreds in these traits. Additive effects of Holstein were greater than Ayrshire, Jersey, and Red Dane for postpartum body weights and average size. All constants for heterozygotic effect combinations were significant for postpartum weights and average size. Heterozygosity effects increased in magnitude with advancing lactation. Generally, age at first calving and postpartum interval to conception reflected little heterozygotic or maternal effects. There was some indication of breed differences in mean and additive effects for age at first calving.     

Using health status surveys in medical consultations

The goal of this research was to identify patients' preferences for physician inquiry into various aspects of health status and to examine whether the preconsultation availability of health status data (collected from the SF-36 Health Status Questionnaire) influenced the physician's conduct during the consultation. Results from 58 prenatal patient visits yielded the following findings. First, patients expressed strong preferences for physicians to ask about the patient's perceptions of health in general and about physical dimensions of health status such as pain, vitality, and role limitations due to physical functioning. Patients also were more satisfied when doctors were perceived as having asked about these issues. Second, patients varied considerably in their preferences for physician inquiries into psychosocial issues such as social functioning, mental health, and role limitations due to emotional problems. Approximately half the patients wanted these matters discussed, whereas the remainder either did not care or preferred that doctors not ask about these topics. Third, the preconsultation availability of health status information had little effect on the degree to which physicians asked about the patient's health-related quality of life. Clinical implications are discussed.